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PubMed2002

A universal newborn hearing screening program in Taiwan.

OBJECTIVE: Mackay Memorial Hospital and the Children's Hearing Foundation established a pilot universal newborn hearing screening program in November 1998. Our objective was to assess the feasibility, accuracy and cost effectiveness of implementing universal newborn hearing screening in Taiwan. METHOD: Between November 1998 and October 2000 a total of 6765 newborns were screened for hearing loss prior to discharge from the wellborn nursery at Mackay Memorial Hospital. The average age of the subjects at the initial screening test was 52 h. The program employed a three stage hearing screening protocol using transient evoked otoacoustic emmisions (TEOAE) screening with referral for diagnostic auditory brainstem response assessment. RESULTS: The mean TEOAE screening time per ear was 41.43 s. The overall pass rate at the time of hospital discharge was 93.6%. Thus achieving an acceptable referral rate of 6.4% for diagnostic audiological assessments. Nine newborns were identified with permanent bilateral hearing impairment. 26 newborns were identified with permanent unilateral hearing impairment. Infants identified with bilateral hearing loss were immediately referred to the Children's Hearing Foundation for hearing aid assessment and fitting. Infants as young as 5 weeks of age were successfully fitted with hearing instruments and enrolled in the family centered early intervention program at the Children's Hearing Foundation. CONCLUSION: The frequency of bilateral congenital hearing loss requiring amplification in this population is shown to be approximately 1 in 752 newborns. This finding is consistent with previous research, which has indicated hearing loss to be the most frequently occurring birth defect. Universal newborn hearing screening using TEOAEs proved to be a cost effective and feasible method of identifying congenital hearing loss in Taiwan. The existence of many successful screening programs worldwide and the availability of fast, objective, reliable and inexpensive hearing screening procedures means that universal newborn hearing screening is becoming the standard of care.

Acoustic Stimulation↗
PubMed2003

Assessment of cost-effectiveness of universal hepatitis B immunization in a low-income country with intermediate endemicity using a Markov model.

BACKGROUND/AIMS: Most countries with high hepatitis B (HB) virus endemicity and most high-income countries have introduced immunization programmes against this infection. However, several low-income countries with intermediate HB endemicity have not done so. We performed a cost-effectiveness analysis of universal childhood HB immunization in such countries using India as an example, since available data on this aspect are limited. METHODS: Marginal cost of every life-year and quality-adjusted life-year (QALY) gained with universal HB vaccination was calculated using a Markov model. Two types of analyses (including and excluding expenditure on treatment of long-term complications of HB infection) were done. Several sensitivity analyses and Monte-Carlo simulation were performed. RESULTS: Universal immunization reduced the HB carrier rate by 71%, and increased the number of years and QALY lived by a birth-cohort by 0.173 years (61.072 vs. 60.899 years) and 0.213 years (61.056 vs. 60.843 years), respectively. Marginal costs were US$16.27 per life-year gained and US$13.22 per QALY gained, much lower than annual per capita income. One-way sensitivity analysis and Monte-Carlo simulation confirmed the robustness of the conclusions. CONCLUSIONS: Universal HB immunization is highly cost-effective in low-income countries with intermediate endemicity rates.

Cost-Benefit Analysis↗
PubMed2004

Universal antenatal screening for syphilis: is it still justified economically? A 10-year retrospective analysis.

OBJECTIVE: Because universal prenatal screening for syphilis has recently been called into question, we documented the development of syphilis in Austria and analysed the effectiveness of current antenatal syphilis screening practices. METHODS: The development of syphilis in Austria and Vienna was determined based on the data published by the Austrian Bureau of National Statistics (Statistik Austria) and the Vienna Health Authority (Gesundheitsamt Wien, MA15), respectively. The data obtained for Vienna were then compared with those for the remaining eight federal provinces. Also, we retrospectively analysed a total of 34,312 sera obtained between 1988 and 1999 from women screened for syphilis at delivery at the laboratory of the Department of Dermatology, University of Vienna. Serological screening was done with both the Venereal Disease Research Laboratory (VDRL) and the Treponema pallidum haemagglutination (TPHA) assays. Finally, we determined the number of cases of congenital syphilis diagnosed in Vienna between 1988 and 1999. RESULTS: In the past 10 years, the annual number of reported syphilis cases has remained fairly constant. In 1999 and 2000, there were 8.1 and 11.0 notifications of syphilis per 100,000 inhabitants in the capital Vienna, compared with 0.7 and 0.9 in the remaining provinces with a mainly rural character. At delivery, there were 96 cases of maternal syphilis that were both TPHA- and fluorescent treponemal absorption (FTA-ABS)-reactive, corresponding to a seroprevalence of 2.8 per 1000 births. Only 24 of the TPHA-reactive sera were VDRL-reactive. In Vienna, there were three stillbirth deliveries due to congenital syphilis and six cases of confirmed congenitally syphilis between 1988 and 1999. CONCLUSION: Universal syphilis screening may no longer be justified economically. The usefulness of VDRL-based syphilis screening should be reassessed. The screening focus should shift to regions with a high seroprevalence of syphilis. Universal syphilis screening does not appear warranted.

Adult↗
PubMed1997

Report on the meeting held at City University, London on 16 December 1996: recent progress in DNA repair, mutation and recombination.

This one-day DNA repair meeting was held at City University, London for the fourth consecutive year (P. Strike, Recent advances in DNA repair, mutation and recombination-a report of the meeting of the British Photobiology Society, London, 20 December 1993, Mutation Res. 315 (1994) 75-84; P. Strike, Recent advances in DNA repair and recombination: a report of the DNA Repair Network held at City University, London on 19 December 1994, Mutation Res. 337 (1995) 61-71 ; N.J. Jones, P. Strike, Recent research in DNA repair, mutation and recombination: a report of the DNA Repair Network meeting held at City University, London on 18 December 1995, Mutation Res. 364 (1996) 13-23). The programme consisted of 18 pre-offered talks, there being no specially invited speakers. The meeting was well attended with over 150 participants representing 23 universities, research institutes and hospitals the length and breadth of the United Kingdom. Overseas attendees represented laboratories from Japan, The Netherlands and Spain. The topics of the talks were varied and included mismatch repair, the repair of oxidative damage, transcription-coupled repair and various mutagen-hypersensitive human syndromes. Although wide-ranging, one recurring themes in many of the talks was that of homologous proteins and the correspondence of repair mechanisms in bacterial, fungal and mammalian systems.

Adenosine Triphosphatases↗
PubMed1999

Improved cardiac preservation by the addition of nitroglycerine to colloid-free University of Wisconsin solution (MUW).

BACKGROUND: This study examines whether the addition of nitroglycerine, a known coronary vasodilator and nitric oxide donor, to colloid-free University of Wisconsin solution will improve and extend cardiac preservation. METHODS: Rat hearts were flushed and stored in colloid-free University of Wisconsin solution with or without the addition of nitroglycerine for 12, 16 or 20 hours at 0 degrees C before heterotopic transplantation with an indwelling externalized intraventricular balloon-tipped catheter. One and 7 days after transplantation of the heart the catheter was connected to a pressure transducer and quantitative functional studies were performed. RESULTS: After 12 hours preservation with nitroglycerine in colloid-free University of Wisconsin solution 6/6 grafts continued to beat for 7 days compared to 3/6 without nitroglycerine. After 16 hours preservation the addition of nitroglycerine 5/7 hearts continued to beat for 7 days compared to 0/6 without nitroglycerine (p < .05). Only 1/6 hearts beat for 7 days after 20 hours preservation with nitroglycerine. On Days 1 and 7, the left ventricular developed pressure (LVDP), contractility (max dP/dt) and rate of relaxation (peak -dP/dt) of 12 hour preserved hearts was better (p < .05) when nitroglycerine was present. The function of hearts preserved with the addition of nitroglycerine was similar after 12 and 16 hours preservation. CONCLUSION: Nitroglycerine is a valuable additive to colloid-free University of Wisconsin solution, extending effective preservation of the rat heart to 16 hours and significantly improving left ventricular function after 12 and 16 hours preservation. The addition of nitroglycerine, however, did not extend preservation to 20 hours.

Adenosine↗
PubMedDate not supplied

A proposed universal medical and public health definition of terrorism.

The lack of a universally applicable definition of terrorism has confounded the understanding of terrorism since the term was first coined in 18th Century France. Although a myriad of definitions of terrorism have been advanced over the years, virtually all of these definitions have been crisis-centered, frequently reflecting the political perspectives of those who seek to define it. In this article, we deconstruct these previously used definitions of terrorism in order to reconstruct a definition of terrorism that is consequence-centered, medically relevant, and universally harmonized. A universal medical and public health definition of terrorism will facilitate clinical and scientific research, education, and communication about terrorism-related events or disasters. We propose the following universal medical and public definition of terrorism: The intentional use of violence--real or threatened--against one or more non-combatants and/or those services essential for or protective of their health, resulting in adverse health effects in those immediately affected and their community, ranging from a loss of well-being or security to injury, illness, or death.

Crisis Intervention↗
PubMedDate not supplied

4D-fingerprints, universal QSAR and QSPR descriptors.

An elusive goal in the field of chemoinformatics and molecular modeling has been the generation of a set of descriptors that, once calculated for a molecule, may be used in a wide variety of applications. Since such universal descriptors are generated free from external constraints, they are inherently independent of the data set in which they are employed. The realization of a set of universal descriptors would significantly streamline such chemoinformatics tasks as virtual high-throughout screening (VHTS) and toxicity profiling. The current study reports the derivation and validation of a potential set of universal descriptors, referred to as the 4D-fingerprints. The 4D-fingerprints are derived from the 4D-molecular similarity analysis. To evaluate the applicability of the 4D-fingerprints as universal descriptors, they are used to generate descriptive QSAR models for 5 independent training sets. Each of the training sets has been analyzed previously by several varying QSAR methods, and the results of the models generated using the 4D-fingerprints are compared to the results of the previous QSAR analyses. It was found that the models generated using the 4D-fingerprints are comparable in quality, based on statistical measures of fit and test set prediction, to the previously reported models for the other QSAR methods. This finding is particularly significant considering the 4D-fingerprints are generated independent of external constraints such as alignment, while the QSAR methods used for comparison all require an alignment analysis.

Anesthetics, General↗
PubMed1994

Innate and universal facial expressions: evidence from developmental and cross-cultural research.

The idea of innate and universal facial expressions that have links with human emotions was given the status of scientific hypothesis by Darwin (1872/1965). Substantial evidence, old and new, supports his hypothesis. Much of the evidence is independent of language, but Russell's (1994) criticisms of the hypothesis focus on language-dependent data. In this article, it is argued that Russell's critique was off target in that his arguments relate only to a hypothesis of the universality of semantic attributions and overstated in that he used questionable logic in designing studies to support his claims. It is also argued that Russell misinterpreted the relation between the universality hypothesis and differential emotions theory. Finally, new evidence is presented that supports the Darwinian hypothesis of the innateness and universality of the facial expressions of a limited set of emotions and the efficacy of the most commonly used method of testing it.

Aging↗
PubMed2000

A flat Universe from high-resolution maps of the cosmic microwave background radiation

The blackbody radiation left over from the Big Bang has been transformed by the expansion of the Universe into the nearly isotropic 2.73 K cosmic microwave background. Tiny inhomogeneities in the early Universe left their imprint on the microwave background in the form of small anisotropies in its temperature. These anisotropies contain information about basic cosmological parameters, particularly the total energy density and curvature of the Universe. Here we report the first images of resolved structure in the microwave background anisotropies over a significant part of the sky. Maps at four frequencies clearly distinguish the microwave background from foreground emission. We compute the angular power spectrum of the microwave background, and find a peak at Legendre multipole Ipeak = (197 +/- 6), with an amplitude delta T200 = (69 +/- 8) microK. This is consistent with that expected for cold dark matter models in a flat (euclidean) Universe, as favoured by standard inflationary models.

Journal Article↗
PubMed2001

Universal trees based on large combined protein sequence data sets.

Universal trees of life based on small-subunit (SSU) ribosomal RNA (rRNA) support the separate mono/holophyly of the domains Archaea (archaebacteria), Bacteria (eubacteria) and Eucarya (eukaryotes) and the placement of extreme thermophiles at the base of the Bacteria. The concept of universal tree reconstruction recently has been upset by protein trees that show intermixing of species from different domains. Such tree topologies have been attributed to either extensive horizontal gene transfer or degradation of phylogenetic signals because of saturation for amino acid substitutions. Here we use large combined alignments of 23 orthologous proteins conserved across 45 species from all domains to construct highly robust universal trees. Although individual protein trees are variable in their support of domain integrity, trees based on combined protein data sets strongly support separate monophyletic domains. Within the Bacteria, we placed spirochaetes as the earliest derived bacterial group. However, elimination from the combined protein alignment of nine protein data sets, which were likely candidates for horizontal gene transfer, resulted in trees showing thermophiles as the earliest evolved bacterial lineage. Thus, combined protein universal trees are highly congruent with SSU rRNA trees in their strong support for the separate monophyly of domains as well as the early evolution of thermophilic Bacteria.

Amino Acid Sequence↗
PubMed2006

Is our Universe natural?

It goes without saying that we are stuck with the Universe we have. Nevertheless, we would like to go beyond simply describing our observed Universe, and try to understand why it is that way rather than some other way. When considering both the state in which we find our current Universe, and the laws of physics it obeys, we discover features that seem remarkably unnatural to us. Physicists and cosmologists have been exploring increasingly ambitious ideas in an attempt to explain how surprising aspects of our Universe can arise from simple dynamical principles.

Journal Article↗
PubMed1999

A survey of oral implantology teaching in the university dental hospitals and schools of the United Kingdom and Eire.

AIM: To provide an overview of the currently available academic teaching and clinical training in oral implantology at the university dental schools and hospitals of the United Kingdom and Eire. METHOD: A questionnaire was sent to the dean or director of dental studies and forwarded to the respective units involved in the academic teaching and clinical training of oral implantology. The setting was the university dental hospitals, and dental schools of the UK and Eire. Information was collected between July 1997 and March 1999. The main outcome measures were course availability, duration and emphasis for undergraduate and postgraduate study in the clinical discipline of oral implantology. The units or departments responsible for training and teaching were identified and formal degree courses were distinguished from non-degree courses. RESULTS: All institutions replied to the survey. All university dental schools provide undergraduate training in oral implantology in accordance with the guidelines provided by the General Dental Council. However, the courses vary with regard to the departments involved and the level of student participation. Thirteen centres provide informal postgraduate training with the duration ranging from one to eighteen days. Just eight centres provide formal academic graduate training based on oral implantology leading to recognised degrees. CONCLUSION: All university dental schools provide undergraduate teaching in oral implantology. Most centres also provide informal postgraduate training based on oral implantology. However, opportunities for academic graduate training, leading to recognised qualifications in this subject, appear limited at present.

Certification↗
PubMed2001

Hepatitis B vaccine: risks and benefits of universal neonatal vaccination.

Global eradication of hepatitis B, which has infected over 2000 million people worldwide, is an achievable goal. Hepatitis B vaccine is effective and safe, and is recommended in Australia as a four-dose childhood schedule commencing with a neonatal dose. A neonatal dose has a greater impact on carriage, the main reservoir of transmission, due to the inverse relationship of age and risk of chronic carriage. Universal vaccination is clearly cost-effective in countries of high hepatitis B endemicity but less so in countries of low endemicity. Other factors affecting the perceived benefits of universal vaccination in low-risk countries include the use of the preservative thiomersal in hepatitis B vaccines, and case reports of multiple sclerosis (MS) and unexplained fever in recipients. Careful epidemiological studies have failed to confirm any risk of MS or fever with the hepatitis B vaccine, which is now thiomersal-free. Other arguments against universal vaccination include 'unnecessary' vaccination of low-risk neonates. However, selective vaccination programmes targeting at-risk neonates are often poorly implemented and do not protect against horizontal transmission in early childhood. Universal vaccination, which is safe and effective, is the only practical means of achieving global eradication of hepatitis B.

Australia↗
PubMed2000

Depigmentation of the normally pigmented patches in universal vitiligo patients by cryotherapy.

BACKGROUND: Complete depigmentation may occur, albeit rarely, in patients with universal vitiligo. They usually have one or more pigmented patches that remain normal, most frequently over the malar area of the face and dorsal aspects of forearms. Total repigmentation may not occur in these patients, even after receiving 150 session of PUVA therapy alone or in conjunction with other medical or surgical procedures, and there is possibility of recurrence after cessation of therapy. These patients are usually more interested in depigmentation rather than trying for repigmentation. OBJECTIVE: Because of the relatively high sensitivity of melanocytes to cryotherapy and the possibility of isomorphic phenomenon in vitiligo patients, removal of the remaining normally pigmented patches was attempted in patients with universal vitiligo using cryotherapy. METHOD: Five volunteer patients with universal vitiligo were chosen, all of whom wished to have their pigmented patches removed. In all five patients a small area was tested first in order to assure the patients of what the procedure involved and to show its likely result. All pigmented areas were then treated to 1-3 sessions of cryotherapy using a closed contact CO2 cryogun, with 4-6-week intervals. RESULTS: Complete and permanent depigmentation was achieved in all five patients with excellent cosmetic results and no complications or scarring. CONCLUSION: Cryotherapy is a cost effective, non-complicating, easily available procedure which can be used for depigmentation of normally pigmented patches in patients with universal vitiligo.

Adult↗
PubMed2000

Breast Disease-Related Educational Outcomes at the University of Florida.

The purpose of this study was to assess resident knowledge related to breast disease at the University of Florida. In addition, we surveyed graduates of our surgery program regarding the importance of breast disease in their surgical practice and we determined if the completion of postgraduate courses on breast disease influenced patient outcome measures. In the decade of the 1990s, we compared the American Board of Surgery In-Service Training Examination (ABSITE) scores of residents rotating on the breast service in the 6 months immediately prior to examination (June-January) with those residents who had not rotated on the breast service within the 6 months leading up to the ABSITE examination. We also compared ABSITE scores of surgery residents at the University of Florida at Gainesville (breast service) to surgery residents at the University of Florida at Jacksonville (no breast service). Finally, we surveyed graduates of the general surgery program at the University of Florida at Gainesville (1980-1998) to determine the importance of breast disease in their practices and if the completion of postgraduate courses on breast disease influenced rates of breast conservation and immediate breast reconstruction. Residents who rotated on the breast service in the 6 months prior to the ABSITE had significantly fewer incorrect breast-related ABSITE questions than residents who had not rotated on the breast service. Those graduates who had taken postgraduate courses in breast disease responded that they were more likely to perform breast-conserving surgery. There was also a trend for graduates who had completed postgraduate courses on breast disease to respond that they were more likely to perform immediate breast reconstruction following mastectomy. Limiting breast surgery to a single service does not appear to improve resident accumulation and retention of breast disease-related knowledge. Graduates who complete postgraduate courses related to breast disease are more likely to perform breast-conserving surgery and immediate reconstruction following mastectomy. Since the management of breast disease comprises a significant part of general surgical practice, surgical educators must ensure adequate resident education and evaluation with respect to breast disease.

Journal Article↗
PubMedDate not supplied

Confronting barriers to universal screening for domestic violence.

Nationally, domestic violence has reached epidemic proportions. Universal screening is a vital means to identify those women who suffer in abusive relationships with intimate partners. Collaborative efforts between a community shelter for abused women and a local medical center's emergency department resulted in the development and implementation of a universal screening process. Barriers encountered by the emergency department nursing staff during the initial phase of screening included lack of information about domestic violence issues as well as about the tool, personal perceptions and feelings about domestic violence, and institutional barriers such as lack of time, space, and privacy in the emergency department. Of these, informational and affective barriers of nursing staff are viewed as the most significant. Discussion includes a call for emphasis on domestic violence in the curricula of nursing programs and those of other health care providers and use of universal screening to identify and assist abused women. Interdisciplinary methods of formal education, in-service training, and continuing education are encouraged to augment existing universal screening, as well as to assist those who have yet to implement such a process.

Adolescent↗
PubMed2002

Prevalence of asthma, allergic rhinitis and eczema among university students in Bangkok.

Prevalence of childhood asthma is increasing worldwide including in developing countries such as Thailand. Despite a wide availability of epidemiological data on childhood asthma in Thailand, prevalence of asthma in adults has not been well studied within this community. Objectives of this study were to study prevalence of asthma, allergic rhinitis and eczema in a random group of university students in Bangkok using the standardized written and video questionnaires from the ISAAC phase I protocol. The ISAAC phase I, written and video (International version, AVQ 3.0) questionnaires were administered to 3631 randomly selected university students from six universities in Bangkok. The age range of subjects were between 16-31 years (mean +/- SD= 19.1 +/- 1.7 years). There were 1197 males and 2434 females (ratio = 1:2.03). Data were entered into and analysed by the EpiInfo 4 program. Prevalence of wheeze within the past 12 months and of diagnosed asthma for this group of subjects was 10.1% and 8.8%. Prevalence of allergic rhinitis (nasal with eye symptoms within the past 12 months) was 26.3% and of eczema (rash at typical sites of atopic dermatitis, within the past 12 months) was 9.4%. Presence of rhinoconjunctivitis, gender and age were significant risk factors for asthma with male, younger subjects and those with rhinoconjunctivitis reported more frequent asthma-related symptoms (P < 0.01). As in previous studies which found an increase in asthma among Thai children, this survey indicates that the prevalence of asthma among Thai university students has increased to the same level as in several European countries. A large number of adults residing in Bangkok are suffering from rhinitis-related symptoms, the majority of which probably represents allergic rhinitis.

Adolescent↗
PubMed2002

[Development of ultrasonography in a radiological university department from 1994 to 2001].

BACKGROUND: In 1994, 5 % of a total of 25 718 examinations and 7 % of all 4630 B-mode sonograms performed in the Radiology Department, University of Cologne was classified as not indicated. In light of these results, the health care policy guidelines for sonographic indications have been amended. PURPOSE: The aim of this study was to establish the current rate of non-indicated sonographic examinations performed in routine diagnostics by radiology departments at university hospitals, to determine the reasons for such over-diagnosis and identify which regulatory mechanisms can be implemented to prevent his. METHOD: We counted the number of 1) B-mode and 2) color-flow Doppler ultrasound imaging procedures carried out in patients who had had no change in symptoms within the previous 4 weeks or who were scheduled without reference to an existing sonogram (double examinations). 3) The reasons for over-diagnosis were analyzed. 4) The 1994 survey was repeated in 2000 with an identical protocol and 5) additionally, a modified survey of the diagnostic questions was conducted. RESULTS: 1) Out of 4,119 patients presenting for the first time to receive a B-mode sonogram, 443 prior sonograms (11 %), 305 CT scans (7 %) and 57 MRI scans (1 %) were documented. 2) Double sonograms were carried out in 6 % of the 1,118 patients presenting for the first time for color-flow Doppler ultrasounds and in 16 % of the 651 patients assigned to receive catheter angiographies with arterial color-flow Doppler. 2) 41 out of 55 (75 %) prior sonograms from non-university settings stated by 94 surgery patients were listed in the medical records. 36 out of 43 (84 %) prior sonograms from the university hospital were repeated in the same patients despite the fact that the medical report with the findings was available. None of the 48 sonograms indicated to confirm a plausible finding yielded any information that was additionally relevant to therapy. 4) In the period April - June, 2000, 12 % of all 15,921 tests and interventions, 26 % of 3,569 B-mode sonograms and 58 % of 1,033 abdominal sonograms performed in adults were classified as having not been indicated. 5) Staging and follow-up were stated as the most common reasons that a sonography was carried out in 46 % of the 1,017 adults who were given B-mode sonograms conducted from Jan - Mar, 2000 and comprised 62 % of the 410 sonograms classified as not or probably not medically indicated. CONCLUSION: The results showed that a multidisciplinary consensus was required to establish the diagnostic value of sonographic procedures. Therefore, this research group drafted a hospital-internal interdisciplinary guideline for "abdominal transcutaneous B-mode sonography in oncological questions".

Diagnostic Imaging↗